Talk Birth

Putting together a written birth plan is an important way to communicate with your care providers about the exact kind of birth you wish for.  If you are planning a hospital birth, you don’t want to be expending your energy while you are in labor fighting with the nurses because what you want might not be what they want.  They have some protocol that they generally follow as a part of their job, so they may want to do certain procedures as a sort of “default”, not always as a “necessity”.  You may or may not agree with some of this, so it is up to you to plan ahead!  Another great thing that comes out of putting a birth plan together—it requires you to do research!  With a higher level of informed consent, you will be more confident in your decisions.  So, where do you begin?

Birth plans are probably most useful for hospital births.  But it is not a bad idea to put one together even if you are birthing at home (or in a freestanding birth center).  You want to make sure that everyone knows what kind of experience you are looking for.  Also, if you are planning a home birth, putting a birth plan together is a great idea in the rare possibility of needing to have an emergency hospital transport.

The top of your birth plan may list your name, the name of your doctor/midwife, the location you are birthing in, the baby’s name, and who will be present for the birth (spouse, partner, doula, etc).  You want to keep your written plan clear, concise, and organized.  Consider labeling each section with a topic such as “Labor”, “Pain Medication”, “Monitoring”, etc., and list all of your requests underneath each section.

Some things to consider for laboring: Do you want to wear your own clothes, or a hospital gown?  Do you wish to be able to move around freely during birth, and not required to stay in bed on your back with legs in stirrups?  Would you like to use natural forms of pain relief such as use of a birth ball, water, or jacuzzi tub?  Would you like the lights in the room to be dim?  Should you make staff aware if someone may be taking photos and/or video during and after the labor/birth?  Do you want an IV, or would you rather be allowed to stay hydrated through drinking water, and only be required to have an IV if you become dehydrated?  Do you wish to eat during labor if you are hungry? Do you want minimal vaginal exams to prevent infection, or would you rather get checked every hour or so to hear your progression?  During every vaginal exam, do you want to be told your dilation, effacement, and station of the baby?  If you are looking to have a natural birth, you might want to request to be put in the care of nurses who support this.  How do you feel about medical students, interns, or residents observing or delivering your baby?

Under “Monitoring”–Would you prefer intermittent fetal monitoring rather then continuous fetal monitoring (if there is a problem with the baby’s health, this might not be an option).  With continuous fetal monitoring, you are often tied to the bed, and may have a hard time moving into positions that may be most comfortable to labor in.

Now let’s think about what might happen if your labor isn’t progressing as quickly as the hospital staff would like to see (this doesn’t necessarily present a problem–babies often progress at their own speed, some are just faster then others).  What do you want to do if your care provider brings up augmenting the labor/inducing?  Are you ok with artificial/chemical methods of attempting this (such as cervidil, pitocin, amniotomy, cytotec), or would you prefer to let nature take its course and labor for as long as your baby needs?  You can request natural methods of augmentation first, such as changing positions and nipple stimulation.

If you are planning a natural birth, you might want to request that staff not offer you pain medications, and that you will ask for them if you feel a need for them.  Also, as a part of charting requirements, the nurses might ask you what level of pain you are experiencing throughout your labor (such as on a scale of 1-10).  Will this just annoy you, or is it no big deal and you are happy to answer?

When it comes time for pushing, do you wish to birth your baby in any position that is comfortable for you (hands and knees, squatting, or standing)?  How do you feel about forceps or vacuum extraction?  Would you prefer to push when you feel the urge rather then be coached on pushing because you are 10cm dilated (just because you are fully dilated doesn’t always mean it is time to push yet).  Do you want to push as you feel the need, or would you rather have the nurses count for you?  Would you rather tear naturally and use methods to avoid an episiotomy (warm compresses, perineal massage)?  Do you want a mirror available and the ability to touch the baby’s head as he/she is crowning?  Do you want the baby put on your chest immediately after the birth?

Immediately after your baby is born, do you prefer to birth your placenta when it is ready to separate on its own rather then having the doctor tug on the cord?  Do you want to wait until the cord has stopped pulsating before cutting it, or do you want to cut and clamp immediately?  Who is going to cut the cord?  Are you doing cord blood banking?  Would you like the baby to be evaluated in your presence?  Do you want to know your baby’s Apgar scores?  How do you feel about the doctor administering a Hepatitis B and Vitamin K shot to your newborn?  How about eye ointment/drops (erythromycin)?  If you do want the eye drops given, would you prefer that they are delayed until after the initial bonding?  Do you want to see your placenta?  Would you like to keep it, and take it home (possibly for encapsulating or burying)?  A lot of hospitals administer a routine shot of pitocin to the mother after the delivery.  Do you only want to receive this shot if medically necessary?  What about where your baby stays?  Do you want to make sure your baby rooms in with you at all times?

When it comes to breastfeeding, there are things to consider so that nothing gets in the way of initiating this relationship.  You would want to get that baby latched on as soon as he/she seems ready after the birth (the sooner the better, usually within the first hour of birth).  It would be important to write about bottles in your birth plan.  If you are wanting to exclusively breastfeed, and get that baby latched on properly, you may want to consider asking that none of the staff give the baby a bottle, unless truly medically necessary (this bottle may contain glucose water, plain water, or formula).  You can also request no pacifiers be given to your baby.  Do you want to meet with a lactation consultant to help with the breastfeeding process?  Perhaps you might consider asking if the hospital has an IBCLC on staff (International Board Certified Lactation Consultant).

If there is a real emergency that warrants a cesarean, you have options (but you can also mention in your birth plan that you would like to do anything possible to avoid a cesarean).  Who do you want in the operating room with you?  How do you feel about having your arms put in restraints during the procedure?  Do you still want to delay the umbilical cord cutting until it has stopped pulsating?  How do you feel about the erythromycin if it wasn’t a vaginal delivery?  Do you want to be given sedatives after the procedure (very often a common practice), or would you prefer to stay awake (especially to initiate breastfeeding/bonding)?  If the baby is healthy, is it possible to start nursing him/her on the operating table while they sew you up?  Or can they give the baby to your partner?  Also, if the baby is doing well post-surgery, and if there are enough neo-natal nurses on staff, you can request that they tend to him/her right there (instead of away in a nursery) so that there is no family separation during recovery.  If the baby needs to go to the nursery, do you want your partner to go with the baby?  Do you want someone to come take your partner’s place in the OR if this occurs (so you continue to have support)?  Do you want the IV required for surgery to be put in your arm vs. your hand (the IV will need to stay in for a day or two after surgery, and having it in the hand can make nursing difficult)?  What kind of incision do you want (such as bikini)?  What kind of repair do you want (double closure or single closure sewing up of the uterus)?

This article listed some of the most common options you will face in a hospital setting.  You don’t need to include every single one in your personal birth plan–choose what is most important to you (but it is more then ok if you feel the need to include all of it).  There is no room to go over all of the pros and cons of each procedure or request you may have in this article (they will be discussed in later articles).  The hope is that you will become aware of procedures and options after having read this, and research each one on your own before you make a decision.  It is important that you go over your wishes well in advance with your care provider, birth partner(s), and hospital staff so that you are confident everyone is going to support your requests.  If you are planning a hospital birth, schedule your hospital tour earlier then later so that you know if they support your plan (you want to have time to find a new hospital or provider in the even that they will not go along with your wishes).  Make sure that everyone has a copy of your birth plan ahead of time, and bring extra copies to the hospital when you are in labor to give to all of the nurses on staff.  The internet is a great resource for finding sample layouts of birth plans.  Good luck to you, and happy birthing!